THE EFFICACY OF SPINAL MANIPULATION, AMITRIPTYLINE AND THE COMBINATION OF BOTH THERAPIES FOR THE PROPHYLAXIS OF MIGRAINE HEADACHE

Background: Migraine headache affects approximately 11 million adults in the United States. Spinal manipulation is a common alternative ther apy for headaches, but its efficacy compared with standard medical the rapies is unknown. Objective: To measure the relative efficacy of amit riptyline, spinal manipulation and the combination of both therapies f or the prophylaxis of migraine headache. Design: A prospective, random ized, parallel-group comparison. After a 4-wk baseline period, patient s were randomly assigned to 8 wk of treatment, after which there was a 4-wk follow-up period. Setting: Chiropractic college outpatient clini c. Participants: A total of 218 patients with the diagnosis of migrain e headache.Interventions: An 8-wk course of therapy with spinal manipu lation, amitriptyline or a combination of the two treatments. Main Out come Measures: A headache index score derived from a daily headache pa in diary during the last 4 wk of treatment and during the 4-wk follow- up period. Results: Clinically important improvement was observed in b oth primary and secondary outcomes in all three study groups over time . The reduction in headache index scores during treatment compared wit h baseline was 49% for amitriptyline, 40% for spinal manipulation and 41% for the combined group; p = .66. During the posttreatment follow-u p period the reduction from baseline was 24% for amitriptyline, 42% fo r spinal manipulation and 25% for the combined group; p = .05. Conclus ion: There was no advantage to combining amitriptyline and spinal mani pulation for the treatment of migraine headache. Spinal manipulation s eemed to be as effective as a well-established and efficacious treatme nt (amitriptyline), and on the basis of a benign side effects profile, it should be considered a treatment option for patients with frequent migraine headaches.